TY  - JOUR
A1  - Fabritius, Matthias Philipp
A1  - Wölfer, Teresa A.
A1  - Herzberg, Moriz
A1  - Tiedt, Steffen
A1  - Puhr-Westerheide, Daniel
A1  - Grosu, Sergio
A1  - Maurus, Stefan
A1  - Geyer, Thomas
A1  - Curta, Adrian
A1  - Kellert, Lars
A1  - Küpper, Clemens
A1  - Liebig, Thomas
A1  - Ricke, Jens
A1  - Dimitriadis, Konstantinos
A1  - Kunz, Wolfgang G.
A1  - Zimmermann, Hanna
A1  - Reidler, Paul
T1  - Course of early neurologic symptom severity after endovascular treatment of anterior circulation large vessel occlusion stroke: association with baseline multiparametric CT imaging and clinical parameters
JF  - Diagnostics
N2  - Background: Neurologic symptom severity and deterioration at 24 hours (h) predict long-term outcomes in patients with acute large vessel occlusion (LVO) stroke of the anterior circulation. We aimed to examine the association of baseline multiparametric CT imaging and clinical factors with the course of neurologic symptom severity in the first 24 h after endovascular treatment (EVT). Methods: Patients with LVO stroke of the anterior circulation were selected from a prospectively acquired consecutive cohort of patients who underwent multiparametric CT, including non-contrast CT, CT angiography and CT perfusion before EVT. The symptom severity was assessed on admission and after 24 h using the 42-point National Institutes of Health Stroke Scale (NIHSS). Clinical and imaging data were compared between patients with and without early neurological deterioration (END). END was defined as an increase in ≥4 points, and a significant clinical improvement as a decrease in ≥4 points, compared to NIHSS on admission. Multivariate regression analyses were used to determine independent associations of imaging and clinical parameters with NIHSS score increase or decrease in the first 24 h. Results: A total of 211 patients were included, of whom 38 (18.0%) had an END. END was significantly associated with occlusion of the internal carotid artery (odds ratio (OR), 4.25; 95% CI, 1.90–9.47) and the carotid T (OR, 6.34; 95% CI, 2.56–15.71), clot burden score (OR, 0.79; 95% CI, 0.68–0.92) and total ischemic volume (OR, 1.01; 95% CI, 1.00–1.01). In a comprehensive multivariate analysis model including periprocedural parameters and complications after EVT, carotid T occlusion remained independently associated with END, next to reperfusion status and intracranial hemorrhage. Favorable reperfusion status and small ischemic core volume were associated with clinical improvement after 24 h. Conclusions: The use of imaging parameters as a surrogate for early NIHSS progression in an acute LVO stroke after EVT reached limited performance with only carotid T occlusion as an independent predictor of END. Reperfusion status and early complications in terms of intracranial hemorrhage are critical factors that influence patient outcome in the acute stroke phase after EVT.
KW  - stroke
KW  - large vessel occlusion
KW  - multiparametric CT
KW  - CT perfusion
KW  - CT angiography
KW  - NIHSS
KW  - EVT
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242681
SN  - 2075-4418
VL  - 11
IS  - 7
ER  - 
TY  - JOUR
A1  - Herzberg, Moriz
A1  - Dorn, Franziska
A1  - Trumm, Christoph
A1  - Kellert, Lars
A1  - Tiedt, Steffen
A1  - Feil, Katharina
A1  - Küpper, Clemens
A1  - Wollenweber, Frank
A1  - Liebig, Thomas
A1  - Zimmermann, Hanna
T1  - Middle cerebral artery M2 thrombectomy: safety and technical considerations in the German Stroke Registry (GSR)
JF  - Journal of Clinical Medicine
N2  - There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0–2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65–82) and 77 (CI 66–83) years, respectively. Except for baseline NIHSS (15 (CI 10–18) vs. 11 (CI 6–16), p < 0.001) and ASPECTS (9 (CI 7–10) vs. 9 (CI 8–10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7–42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2–8) vs. 2 (CI 2–7)/(CI 2–2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome.
KW  - mechanical thrombectomy
KW  - M2
KW  - distal occlusion
KW  - endovascular therapy
KW  - aspiration
KW  - stent retriever
KW  - outcome
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286052
SN  - 2077-0383
VL  - 11
IS  - 15
ER  - 
TY  - JOUR
A1  - Dorn, Franziska
A1  - Herzberg, Moriz
T1  - Response to Letter to the Editor “Keeping Late Thrombectomy Imaging Protocols Simple to Avoid Analysis Paralysis”
JF  - Clinical Neuroradiology
KW  - neuroradiology
KW  - neurosurgery
KW  - neurology
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-307023
SN  - 1869-1439
SN  - 1869-1447
VL  - 31
IS  - 3
ER  -